AccountId: 011433970860
ContactId: 82483a65-89a6-4ee6-8bea-25eea870e760
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 801210 ms
Total Talk Time (AGENT): 401032 ms
Total Talk Time (CUSTOMER): 238440 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/82483a65-89a6-4ee6-8bea-25eea870e760_20250612T20:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I was trying to log in online to see one of the claims that I submitted. Um, I received the payment, but, uh, for some reason I was not able to log in. Um, it says that they couldn't find my account, so I'm calling to see if there's any way that you can look it up and let me know how much, um, it was paid for it.
[AGENT][NEUTRAL] OK, I can help you with, uh, with your claim, [PII], and I can help you with your OSC account, um, as well. Can I go ahead and get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] And what is your policy number?
[CUSTOMER][NEUTRAL] Uh, policy number is
[CUSTOMER][NEUTRAL] 2267415
[AGENT][NEUTRAL] Alright, give me just a second to look that up, OK?
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] And can I get you to verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the address that we have on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And did you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Uh, let me see, I have a reference number or a claim number I have it. It's 3505249.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Uh, it looks like this claim was processed on [PII].
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Yeah, I know it was last year, but um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh it was a duplicate so let me find the original just real quick.
[AGENT][NEUTRAL] Uh, I can tell you that one of the services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Looks like it's not covered, but let me go ahead and look. It looks like the date of service might have been [PII]. Does that sound about right?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, give me just one moment and I'll look it up that way.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] Yes, it looks like that was processed on [PII].
[AGENT][NEUTRAL] We did pay the amount of $200.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, there is only one that looks like it wasn't, uh, the policy does not provide a benefit for prescription drugs, so that was the only service that got denied on that claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, that's fine, because the one that I was interested in it was the ER um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The visit, uh, yeah, because I ended up paying $916 so that's why I, I was not sure how much um I got paid for this one, so I, that's why I needed to check.
[AGENT][NEUTRAL] Yeah, it looks like we paid $200 towards this.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, and also like, how can I see or what can I check, you know, like what's the percentage of how much you pay towards that claim or how does it work?
[AGENT][NEUTRAL] So it'll be in your policy documents. So, um, are you near a computer and we can work on setting up your OSC account? because I know you said you're having some issues with it.
[CUSTOMER][NEGATIVE] Yeah, I, I did have a login, but when I tried to log in it says that, you know, they couldn't find it, and then when I put forgot password and they verify my email, but there was nothing, you know, like I couldn't even change it, so.
[CUSTOMER][NEUTRAL] I, I'm in the computer now.
[AGENT][NEUTRAL] Yeah, so, um,
[AGENT][NEUTRAL] OK, so when you go to [PII], so we did get a new OSC provider as of Monday last week, so we're asking everyone to create a new account, but everything from your old account will transfer over.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Oh, you know that I tried to do that and then I put, you know, like I click on insure, uh, but when I put my information, it says that they couldn't find it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My information.
[AGENT][NEUTRAL] OK, um, so let's go ahead and go in, let me see, go ahead and go in there.
[AGENT][NEUTRAL] And go back to um click create your own your OSC account.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And click um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Click insured and then only fill out the three boxes that are required which is just last name, email, and uh date of birth.
[AGENT][NEUTRAL] And see if that if that works yeah and it will need to be the email that we have on file which it looks like it's a Gmail account.
[CUSTOMER][NEUTRAL] Oh, OK, OK. Let me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, the [PII], OK, hold on, let me change it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, let me, yeah, he let me go through. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the next portion, uh, you'll want to verify the email address first so uh you'll put in your email, click send the verification code.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go into your um email and it should be an an email from Microsoft on behalf of APL or in regards to APL.
[AGENT][NEUTRAL] Um, you should receive it pretty quickly, yeah, OK, and then verify code and then enter in the new password and um your name and display name and all of that.
[CUSTOMER][POSITIVE] Yes, I got it.
[AGENT][NEUTRAL] Uh, one of the new features that we do have is you're logging in now with an email instead of a username and so you'll ask to verify your email every time you log in now.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] OK, I think, uh, let me check.
[AGENT][NEUTRAL] And if you didn't see the are you on the verification code still or are you on a different section?
[CUSTOMER][NEUTRAL] No, I put all my information, it went through, but now it says that I need to log in again, so it's giving me again, you know, the option for to put that the verification code now, and let me see if it's gonna let me log in. Oh, OK, now I'm, I'm in my dashboard.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you should be able to go to, I b[PII] it is my profile or my policy, and from my policy you'll be able to see your claim documents.
[AGENT][NEUTRAL] And then um I and then you were asking about uh you can see what amounts we pay you'll go to your policy documents.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And you'll look for something that's called a policy certificate.
[AGENT][NEUTRAL] And in order to find the benefit amounts you'll go to uh in your policy certificate go to schedule of benefits and it will have the dollar amounts and uh how much you're allotted for either a calendar year or a calendar day and so all of the amounts will be right there in that schedule of benefits.
[CUSTOMER][NEUTRAL] Oh, OK. Is there a limit, like per year? Uh where can I find that?
[AGENT][NEUTRAL] That will be in your schedule of benefits um let me pull it up.
[AGENT][NEUTRAL] And I can tell you the page number as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So once you go into uh my policy and it should be able to allow you into something called a policy certificate.
[AGENT][NEUTRAL] Um, your policy certificate is 49 pages.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't see it, it, you know, like it says my details and claims.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, I see all the claims, uh, in my details.
[AGENT][NEUTRAL] Really.
[CUSTOMER][NEUTRAL] I don't see.
[CUSTOMER][NEUTRAL] Any documents?
[CUSTOMER][NEUTRAL] Maybe in resource center?
[AGENT][NEUTRAL] You should
[AGENT][NEUTRAL] You should be able to let me see.
[AGENT][NEUTRAL] You should be able to click on them, but let me look.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, I went back to the dashboard. It says, would you like to review the coverage details for your policy? That's the one that I need to check.
[AGENT][NEUTRAL] OK, yeah, go to that one, and let's see, let me get back into your policy.
[CUSTOMER][NEUTRAL] Oh yeah, it takes me to my policy. Mhm.
[AGENT][NEUTRAL] OK. And it's one of 49 pages. You'll scroll all the way down for the dollar amounts. Um, it looks like page 18 is your in hospital benefits. So, um, that's if you're just going into the hospital, you're not staying um for an extended period of time, uh, and it will just show the amount that you're given. It looks like for yours, it goes by calendar year.
[AGENT][NEUTRAL] And then for your, your policy has your in-hospital and your outpatient uh coverages separate. So your inpatient details were on page 18.
[AGENT][NEUTRAL] Uh, your outpatient benefits like the one that you just filed a claim for that will be on page 34.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And this is just a verification of benefits. It's not a guarantee of uh payment, but your outpatient benefit maximum on your policy will show that you're allotted $200 per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] So that's probably why that's why you got the $200 as you were allotted that per day, so you don't have to worry about calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, um, that, so whenever you went to the, the urgent care or the ER, you get up to $200 per calendar date in the ER.
[CUSTOMER][NEUTRAL] On the
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yeah, I like it, it just, uh, like when it says policy details, I cannot, oh I see download documents. I was not able to see it, now it's showing. Now I can see what you were talking about before, for some reason it was not letting me see. OK, so you say page page 18.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Page 18 is your inpatient.
[AGENT][NEUTRAL] Page 34 is your outpatient, so the one that you just, uh, we just went over why we paid you the $200 for the ER, your ER benefits are in your outpatient which is on page 34.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And then the rest of the policy has some of your um has uh definitions if you're unsure about what might be covered, um it'll have definitions of, of certain things. It will have, you have some uh treatment writers as well. It looks like it'll, after your uh outpatient benefits, you'll scroll down and then you'll see those uh outpatient treatment writers, they have their own page typically.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, outlining what they do, um, what they're for, what they cover, and then it has how to file an appeal if you ever feel like your claim was denied or it wasn't processed the way you want it to. It shows you, uh, your rights to appeal a claim. So everything should be in that document.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] Um, no, that will be all. Thank you so much.
[AGENT][POSITIVE] Hi, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye.